Guidelines for clinical care: anti-infective agents for intra-abdominal infection. A Surgical Infection Society policy statement
J. M. Bohnen, J. S. Solomkin, E. P. Dellinger, H. S. Bjornson and C. P. Page
University of Toronto, Ontario Faculty of Medicine, Department of Surgery.
Several antibiotics have been marketed for therapeutic use in
intra-abdominal infection. Often, these agents do not provide a sufficient
spectrum activity against both facultative and obligate anaerobic
gram-negative organisms, or have certain toxic effects that would not
otherwise support their use. Guidelines have been developed for selection
of antibiotic therapy for intra-abdominal infections and are presented as a
statement of the Surgical Infection Society endorsed by the Executive
Council. These guidelines are restricted to infections derived from the
gastrointestinal tract and deal with those microorganisms commonly seen in
such infections. The recommendations are based on in vitro activity against
enteric bacteria, experience in animal models, and documented efficacy in
clinical trials. Other concerns regarding pharmacokinetics, mechanisms of
action, microbial resistance, and safety were also used in the formation of
these guidelines. For community-acquired infections of mild to moderate
severity, single-agent therapy with cefoxitin, cefotetan, or cefmetazole or
ticarcillin-clavulanic acid is recommended. For more severe infections,
single-agent therapy with carbapenems (imipenem/cilastatin) or combination
therapy with either a third-generation cephalosporin, a monobactam
(aztreonam), or an aminoglycoside plus clindamycin or metronidazole is
recommended. Regimens with little or no activity against facultative
gram-negative rods or anaerobic gram-negative rods are not considered
acceptable.
